NY Legionnaires' Outbreak Highlights Nationwide Rise

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A large outbreak of Legionnaires' disease in New York City has
put the illness in the spotlight in recent weeks, but experts say
the illness needs more attention in general, as cases have
increased nationwide over the last decade.

Since the outbreak was first reported, on July 10, 86 people in
the South Bronx have been sickened with
Legionnaires' disease, including seven who have died. The
disease is a type of pneumonia caused by the bacteria
Legionella, which live in watery environments. Officials
suspect that five Bronx water-cooling towers, which tested
positive for Legionella, are the cause of the current outbreak.

But only a small portion of Legionnaires' disease cases in the
United States are tied to outbreaks — the rest are individual
cases that pop up sporadically — and the number of cases has been
on the rise across the country in recent years. Over the last
decade, the number of cases of Legionnaires' disease reported to
U.S. public health officials tripled, from 1,127 cases in 2000 to
4,548 cases in 2013, according to a paper
published in the September/October issue of the Journal of Public
Health Management & Practice.

It's not likely this increase is simply the result of better
diagnosis and reporting of cases, said Dr. Ruth Berkelman,
director of the Center for Public Health Preparedness and
Research at Emory University in Atlanta. Berkelman noted that
there have not been changes in diagnosis strategies in recent
years, and the test for Legionnaires' disease came out over a
decade ago.

"The increase is probably real," and the number of cases will
likely continue to rise without consistent prevention strategies,
Berkelman said. "More attention is needed for this disease. It's
been a relatively low public health priority, but it's one of the
leading causes of pneumonia." [ 5
Things You Should Know About Legionnaires' Disease ]

There are many possible reasons for the increase, including a
growing population of older adults, who are at higher risk for
contracting the disease from contaminated water sources (the
disease does not spread from person to person).

Some adults in the baby boomer generation, who are in their 50s
and 60s, also travel a lot, and travel is associated with the
disease, with cases occurring in hotels and on cruise ships,
Berkelman said.

In addition, a greater number of people now take drugs that
suppress their immune
system s, for conditions such as cancer, and having a weakened
immune system also puts people at risk of catching Legionnaires'
disease, Berkelman said.

There are also now more man-made water structures, such as
cooling towers and indoor fountains, than there were several
decades ago, and these increase people's risk of exposure to
Legionella, and could contribute to the rise in cases,
Berkelman said.

To prevent Legionnaires' disease, water systems should be
maintained according to standards, particularly those in hotels
and health care facilities, Berkelman said. Regular testing for
the pathogen, and rules that hold building owners responsible for
water system maintenance, should also be considered, she said.

There should also be more research on the disease so that health
officials can better understand which methods work best to
prevent cases, Berkelman said.